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J Acquir Immune Defic Syndr. 2018 Feb 1;77(2):135-143. doi: 10.1097/QAI.0000000000001588.

Alcohol and Mortality: Combining Self-Reported (AUDIT-C) and Biomarker Detected (PEth) Alcohol Measures Among HIV Infected and Uninfected.

Author information

1
Veterans Aging Cohort Study Coordinating Center, West Haven VA Healthcare System, West Haven, CT.
2
Department of Internal Medicine, Center for Interdisciplinary Research on AIDS (CIRA), Yale School of Medicine, Yale University, New Haven, CT.
3
Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada.
4
British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada.
5
Department of Medicine, UCSF School of Medicine, San Francisco, CA.
6
Department of Health Services, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, WA.
7
VA Pittsburgh Healthcare System, Pittsburgh, PA.
8
Department of Epidemiology, Brown University School of Public Health, Providence, RI.
9
Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA.
10
Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ.
11
National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD.

Abstract

BACKGROUND:

Unhealthy alcohol use may be particularly detrimental among individuals living with HIV and/or hepatitis C virus (HCV), and is often under-reported. Direct biomarkers of alcohol exposure may facilitate improved detection of alcohol use.

METHODS:

We evaluated the association of alcohol exposure determined by both self-report [Alcohol Use Disorders Identification Test-Consumption (AUDIT-C)] and a direct biomarker [phosphatidylethanol (PEth)], with mortality among HIV-infected and HIV-uninfected in the Veterans Aging Cohort Study-Biomarker Cohort. We considered PEth <8 ng/mL to represent no alcohol use. Alcohol exposure by AUDIT-C scores [0, 1-3/1-2 (men/women), 4-7/3-7 (men/women), 8-12] and PEth (<8, ≥8) was combined into categories to model the relationship of alcohol with mortality. Participants were followed from blood collection date for 5 years or until death within 5 years.

RESULTS:

The sample included 2344 (1513 HIV+; 831 uninfected) individuals, 95% men. During a median follow-up of 5 years, 13% died. Overall, 36% were infected with HCV (40% HIV+/HCV+, 27% HIV-/HCV+). Overall, 43% (1015/2344) had AUDIT-C = 0 (abstinence). Of these, 15% (149/1015) had PEth ≥8 suggesting recent alcohol exposure. Among those with AUDIT-C = 0, HCV+ individuals were more likely to have PEth ≥8. After controlling for age, sex, race, HIV, HCV, and HIV viral suppression, those with AUDIT-C = 0 but PEth ≥8 had the highest risk of mortality (adjusted hazard ratio 2.15, 95% confidence interval: 1.40 to 3.29).

CONCLUSIONS:

PEth in addition to self-report may improve detection of alcohol use in clinical settings, particularly among those at increased risk of harm from alcohol use. Individuals infected with HCV were more likely to under-report alcohol use.

PMID:
29112041
PMCID:
PMC5762259
DOI:
10.1097/QAI.0000000000001588
[Indexed for MEDLINE]
Free PMC Article

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